Abstract
An endoscopic local ablation therapy (ELAT) was developed using microwave coagulation therapy and radiofrequency ablation for the treatment of hepatocellular carcinoma (HCC) in 1994. Superficial HCCs, consisting of up to three nodules, if each is smaller than 4 cm, and without vascular invasion, are good candidates for ELAT. ELAT is chosen for patients with HCCs which are inaccessible percutaneously. In our department, percutaneous, endoscopic, and open body approaches were used in 52%, 33% and 15% of the 450 patients treated with thermal ablation, respectively. Thoracoscopic and laparoscopic approaches were selected for HCCs located at the hepatic dome and other sites. Among the 115 patients who were treated with ELAT, the mean tumor size was 25 mm (range : 5 to 50 mm), and the mean tumor number was 2.2 (range : 1 to 5). Patients with liver damage levels of B or C accounted for 68% of those treated. ELAT showed a 95% response rate calculated using the tumor necrosis ratio, and only a 4% local recurrence rate (median observation period : 2.8 years). The average intraoperative blood loss, operating time, blood transfusion, and postoperative hospital stay for patients treated with ELAT was 80 g, 3 hrs, 0%, and 8 days, respectively. These parameters were significantly better than those for patients who underwent partial hepatectomy (680 g, 4.4 hrs, 22% and 20 days). In spite of severe hepatic dysfunction, the 5-year cumulative survival rate in patients treated with ELAT was 60%, which is similar to results following partial hepatectomy. Complication rates in patients treated with ELAT were 6.9%. No tumor recurrence was seen at the portal site, and no implantation of malignant cells was observed. In conclusion, an approach using ELAT is recommended for superficial HCC due to its effectiveness and because it is a less invasive method of treatment.
